Thoracic and Cardiothoracic Disorders Flashcards
Anterior mediastinal masses are likely to be…?
thyroid, lymphoma, thymoma (associated with myasthenia gravis), teratoma/germ cell tumor
Middle mediastinal masses are likely to be…?
lymphoma, sarcoid, metastatis lung cancer, sarcoid
Posterior mediastinal masses are likely to be…?
neurogenic tumors
Middle aged patient, pain in midback/ulnar region refractory to NSAIDs, no cough or SOB, Horner syndrome
pancoast tumor (lung cancer originating from apex of lung), can invade subclavian artery, brachail plexus, and sometimes subclavian gangila
how to diagnose pancoast tumor
CT chest, bronchoscopy, mediastinoscopy, and needle biopsy
Treatment for Pancoast tumor
determine if there is lymphnode involvement or metastases and concurrently treat with chemoradiation…then if no signs of distant mets or local progression, surgically resect!
young patient, nonsmoker presents with recent onset cough, SOB, and hx of hemoptysis…chest xray shows partial collapse or RUL of lung
bronchial adenoma (rare)
How to treat bronchial adenoma?
CT, bronchoscopy, and bronchoscopic biopsy for pathology…then complete reseection of tumor with mediastinal lymph node sampling/dissection…usually curative
65 year old man with chest pain and SOB of 3 months duration, absent breath sounds and dullness to percussion on right lung base…cxr shows opacified right lower lung field with pleural effusion…shipyward worker
likely pleural effusion from mesothelimoa
How to work up pleural effusion
thoracentesis and pleural biopsy
18 year old experiences sudden hest pain follwoed by SOB playing tennis, trachea shifted left and absent breath sounds on right…dx and mechanism?
spontaneous pneumothorax secondary to rupture of apical blebs (formed by breakdown of septae in apex oflung)…rupture will cause air to escape into pleural space, increase interpleural pressure and collapse the lungs…
management of pneumothorax
chest tube with water seal!
How to manage air leak first time and persistent
replace chest tube, most air leaks will resolve this way…or persistent, may need to surgically intervene with pleurodesis to prevent recurrence of pneumothorax
Elderly lady with pneumonia recovers after a week but then notes increased chest pain, cough, recurrent fever…chest xray shows pleural effusion…diagnosis and treatment
empyema
treatment = intiate antibiotics (tailor based on culture and sensitivity), drain pus, and reexpand lung
Presence of ______ is a primary indication for CABG
left main disease or three vessel disaese
Viable alternative to CABG
percutaneous transcatheter coronary angioplasty with stent placement
Common cause of severe mitral regurg in males younger than 50
myxomatous degeneration of mitral valve
most common cause of mitral stenosis
rheumatic fever
treatment for symptomatic mitral valve disase
repair or replacement of mitral valve
repair by excising bad parts of valve and adding annuloplasty ring…replace with prosthetic or biologic valve if repair isn’t feasible
When do symptoms develop in most patients with aortic stenosis?
age 50-60, sometimes being sudden death!
as soon as symptoms start appearing, (syncope, SOB, angina)…2 year survival is low and surgery is indicated
